Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Training in Communication Skills
Various approaches to training physicians to communicate with cancer patients have been instituted to meet these guidelines. One approach is a program titled Oncotalk, a communication skills program built around evidence-based educational techniques. In an intensive 4-day retreat focused on communication at the end of life, medical oncology fellows are exposed to didactic material that incorporates specific interviewing skills. They then interview standardized patients while they are observed by trained facilitators, who act as coaches to help the oncology fellows recognize and deal with obstacles and challenges in the encounter. The curriculum encompasses basic communication skills such as how to respond to emotional concerns and affect and communication skills along the disease trajectory, including the following:[8,9]
- Giving bad news.
- Conducting a family conference.
- Managing the transition from curative to palliative therapy.
- Responding to requests for futile treatments.
Societies such as the American Society of Clinical Oncology (ASCO) have developed and adopted specialized curricula for communicating with older cancer patients. Several authors have published positive results from randomized trials or other outcomes assessments of communication skills training in oncology.[10,11];[12,13][Level of evidence: I][14,15]
Other approaches that have been used to enhance the communication skills of physicians include the following:
- A skills-based approach that designs structured training activities to teach communication skills.
- Development of an innovative assessment instrument to facilitate curricular mapping of palliative care education.
- Efforts to enhance residents' knowledge, skills, and attitudes needed for effective palliative care.
- Listening to the patient and responding with care as a model for teaching communication skills and to frame the patient-physician relationship around trust and respect.
- The use of serial standardized patient-based assessments of medical students' acquisition of core clinical skills.[Level of evidence: II]
Nurses in Communication with Physicians
In general, nurses spend more time with patients than do their physician counterparts. Nurses play a vital role in supporting the patient through the crisis of cancer. Nurses are frequently left to pick up the pieces after physicians have delivered bad news or explained information about an illness. Questions such as "How bad is it?" or "How long do I have to live?" are often posed to nurses by patients who either are reluctant to bother the doctor or feel uncomfortable about asking for information. Nurses play a vital role on the treatment team, advocating for patients and acting as intermediaries for patient requests or concerns. Thus, teamwork between physicians and nurses is essential. However, role and status differences between nurse and physician can sometimes make communication challenging.